Surgical retrieval apparatus

ABSTRACT

A surgical retrieval apparatus includes a specimen retrieval bag including a rim movable from a collapsed configuration when positioned within a delivery tube to an automatically expanded configuration when advanced from the delivery tube. The rim is configured to receive a tissue specimen when the rim is in the expanded configuration. The retrieval bag defines a proximal portion with respect to the incision and a distal portion with respect to the incision. A specimen retrieval system further includes a delivery tube defining a longitudinal axis and includes the surgical retrieval apparatus contained therein that is configured to be inserted through a first opening in a patient&#39;s skin. The delivery tube defines an internal volume extending from a proximal end to a distal end of the delivery tube. The surgical retrieval apparatus is separable from the delivery tube.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/056,217, filed Oct. 17, 2013, by O'Prey et al., published as U.S.Patent Application Publication No. US 2014/0046337 A1, which is acontinuation of U.S. patent application Ser. No. 12/969,679, filed Dec.16, 2010, now U.S. Pat. No. 8,585,712, which claims priority from, andbenefit of, U.S. provisional application Ser. No. 61/301,105, filed Feb.3, 2010, the entire contents of which are incorporated herein byreference.

BACKGROUND

1. Technical Field

The present disclosure relates to a surgical containment apparatus. Moreparticularly, the present disclosure relates to a specimen retrievalapparatus for use in minimally invasive surgical procedures.

2. Background of Related Art

In minimally invasive surgical procedures operations are carried outwithin the body by using elongated instruments inserted through smallentrance openings in the body. The initial opening in the body tissue toallow passage of instruments to the interior of the body may be anatural passageway of the body, or it can be created by a tissuepiercing instrument such as a trocar, or created by a small incisioninto which a cannula is inserted.

Because the tubes, instrumentation, and any required punctures orincisions are relatively small, the surgery is less invasive as comparedto conventional surgical procedures in which the surgeon is required tocut open large areas of body tissue. Therefore, minimally invasivesurgery minimizes trauma to the patient and reduces patient recoverytime and hospital costs.

Minimally invasive procedures may be used for partial or total removalof body tissue or organs from the interior of the body, e.g.nephrectomy, cholecystectomy, lobectomy and other procedures includingthoracic, laparoscopic and endoscopic procedures. During suchprocedures, it is common that a cyst, tumor, or other affected tissue ororgan needs to be removed via the access opening in the skin, or througha cannula. Various types of entrapment devices have been disclosed tofacilitate this procedure. In many procedures where cancerous tumors areremoved, removal of the specimen in an enclosed environment is highlydesirable to prevent seeding of cancer cells.

In minimally invasive thoracic surgery, access to the thoracic cavity islimited as well as maneuverability within the cavity as the access portis placed between the confined space between a patient's ribs. Suchprocedures, commonly referred to as video assisted thorascopic surgery(VATS), aim to reduce patient recovery time by accessing the thoraciccavity through the natural intercostal space without spreading the ribsas in open procedures. This restricted access can sometimes causeproblems when removing large specimens. Moreover, in such procedures,e.g. thorascopic wedge resection and lobectomy, it is often necessary toremove a portion of the lung and retrieve it relatively intact forpathology. It is also important that the specimen be sufficientlycontained to prevent seeding of cancer cells during manipulation andremoval.

In designing such specimen retrieval instrumentation, a balance must bestruck between the need to provide a retrieval apparatus with a strongenough containment bag to prevent tearing or rupture while providingsufficient rigidity to enable manipulation and removal. Another balancewhich needs to be achieved is to provide sufficient maneuverabilitywhile reducing tissue trauma, e.g. damaging lung tissue, duringmanipulation and removal. Additionally, the instrumentation on one handshould be able to be inserted through a small access incision or portwhile on the other hand be able to accommodate a wide range of patientsizes and be able to easily remove large specimens and minimize risk ofseeding.

It would therefore be advantageous to provide a specimen retrievaldevice for minimally invasive surgical procedures with increasedmaneuverability and which minimizes trauma to surrounding tissue andwhich successfully achieves the balance of competing factors enumeratedabove.

SUMMARY

The present disclosure is directed to a surgical retrieval apparatus.The present disclosure provides in one aspect a method of retrieving atissue specimen comprising:

a) inserting a surgical retrieval apparatus through an opening in apatient's skin, the surgical retrieval apparatus including:

-   -   a support member, and    -   a retrieval bag extending from the support member and having an        opening to receive the tissue specimen;

b) placing a net over the tissue specimen; and

c) removing the net and retrieval bag from the patient's body to removethe tissue specimen.

The method preferably further comprises the step of introducing the netinto the retrieval bag. This step in a preferred embodiment occursbefore the step of placing the net over the tissue specimen.

In a preferred embodiment, the net is introduced into the retrieval bagby a grasper with the net positioned on a shaft of the grasper. Themethod can include the step of unrolling the net from a shaft of thegrasper.

The method may further include the step of advancing a second grasperthrough a second opening in the patient's skin into the retrieval bagand grasping the net with the second grasper.

In a preferred embodiment, the retrieval bag is positioned within a bodycavity with an opening of the bag facing transversely with respect tothe incision. A second grasper can be inserted through the transverselypositioned opening.

The net preferably has a diameter less than the diameter of the tissuespecimen to grip the tissue sample and maintain its position duringremoval.

In some embodiments, the step of inserting the surgical apparatusincludes the step of inserting the apparatus into the thoracic cavity.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the presently disclosed specimen retrieval apparatus aredescribed hereinbelow with reference to the drawings wherein:

FIG. 1 is a perspective view of the retrieval bag of the specimenretrieval apparatus of the present disclosure in the collapsed insertionposition within a delivery tube and shown outside the body cavity;

FIG. 2 is perspective view of the delivery tube and specimen retrievalapparatus of the present disclosure being inserted through an incisioninto the body cavity;

FIG. 3 is a perspective view of the retrieval bag being advanced by theuser through the delivery tube;

FIG. 4 is a perspective view illustrating the user grasping the proximalportion of the retrieval bag after removal of the delivery tube;

FIG. 5 is a perspective view illustrating a grasper with a netpositioned thereon being inserted through the retrieval bag to grasp thetissue specimen and place it in the retrieval bag;

FIG. 6 is a perspective view illustrating a second grasper beinginserted through a port extending through a second incision to unrollthe net over the tissue specimen;

FIG. 7 is a perspective view illustrating the user grasping the proximalportion of the net to begin to pull the net through the incision; and

FIG. 8 is a perspective view illustrating the bag and net being pulledthrough the incision.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Embodiments of the present disclosure will now be described in detailwith reference to the drawings, in which like reference numeralsdesignate identical or corresponding elements in each of the severalviews. As used herein, the term distal refers to the portion of theinstrument which is further from the user while the term proximal refersto that portion of the instrument which is closer to the user.

The surgical retrieval apparatus disclosed herein may find use in anyprocedure where access to the interior of the body is limited to arelatively small incision, with or without the use of a cannula, as inminimally invasive procedures. The devices herein may find particularuse in minimally invasive thoracic surgery where access to the thoraciccavity is through a space located between adjacent ribs known as theintercostal space.

Referring initially to FIGS. 1-4, a surgical retrieval apparatus 100 isillustrated. Surgical retrieval apparatus is preferably configured anddimensioned for use in minimally invasive surgical procedures (e.g.thoracic, laparoscopic, endoscopic procedures). Surgical retrievalapparatus 100 includes an elongated supporting member or rim 110 and aretrieval bag 130 supported by the rim 110. As seen in the openconfiguration of FIG. 4, the rim 110 has a substantially oval shape andis of sufficient size so that a first portion, i.e. distal portion 115,is positioned within the body cavity C while a second portion, i.e.proximal portion 114, is positioned external to the cavity C. Similarly,the bag 130 is of a sufficient size to receive a tissue specimen in afirst portion within the body cavity C, while a second portion extendsoutside the body cavity C to be grasped by the user. The rim 110 can becomposed of shape memory material with a shape memorized expandedposition. Alternatively, it can be composed of other materials whichenable collapse/compression of the rim for insertion and expansion forplacement within the body cavity, such as materials exhibitingspring-like characteristics.

The retrieval bag 130 is shown in FIG. 4 in the open position. Onceinserted inside the cavity C, expansion of the rim 110 expands theopening 132 of bag 130 due to the attachment of the bag 130 to the rim110. Opening 132 of bag 130 is oriented transverse to an insertion axis(transverse to a longitudinal axis of the incision) so that it is angledtoward the tissue specimen S. That is, the opening 132 faces the tissuespecimen S. The closed opposite end of the bag is designated byreference numeral 134. The bag is preferably of sufficient size that itmay be partially or fully inserted, depending on the size of the cavity.Additionally, being of a size that the rim extends outside the cavity tobe grasped by the user, the user can always insert or retract the baghowever much bag is introduced.

In use, the rim 110 and retrieval bag 130 can be delivered in acollapsed (e.g. folded) configuration through a delivery device 10 suchas the configuration shown in FIG. 1. As can be appreciated, bydelivering the bag 130 in the collapsed configuration directly through adelivery tube 10 (without an external sleeve as part of the devicepositioned over the bag), the overall profile of the apparatus isminimized which enables a smaller diameter access port or deliverymember to be utilized.

The steps in the method of use of the surgical apparatus will now bedescribed. In addition to the retrieval apparatus 100 having the supportmember 110 and retrieval bag 130, a surgical grasper and a retrieval netare also utilized in the procedure. In one embodiment, the net can becomposed of a polymer mesh, although other materials are alsocontemplated.

In the first step, delivery tube 10, containing the apparatus 100 in thecollapsed or folded position, is placed through the incision I as shownin FIG. 2, with the proximal portion 12 of delivery tube 10 extendingoutside the incision I and body cavity C and the distal portion 14extending into the body cavity C. Next, the apparatus 100 is advancedfrom the delivery tube 10 by the surgeons finger(s) (FIG. 3) oralternatively by a pusher device pushing against a proximal portion 114of rim 110 and/or bag 130. Once a portion of the rim 110 is advanced,e.g. distal portion 115, from the delivery tube 10, it automaticallyexpands towards its normal larger configuration, thereby expanding bag130. Once the apparatus 100 is partially advanced, the delivery tube 10is withdrawn, enabling the remaining proximal portion 114 of the rim 110and attached bag 130 to expand as it is free from the confines of thewall of the delivery tube 10. This expansion of the proximal portion 114maintains this portion external of the incision I, as shown in FIG. 4,as its larger dimension cannot slide through the incision I. It is alsoheld by the user. After withdrawal of the delivery tube 10, as can beappreciated, the rim 110 expands to thereby expand opening 132 of thebag 130 to present a large opening for the tissue specimen S. Note thatthe bag opening 132 is oriented toward the specimen. Also, in someembodiments the bag 130 can be oversized, so that it can be inserted tofill the cavity and the tissue sample S can simply be slid over the rim110 into the bag 130 if desired.

In the next step of the procedure, a grasper 150 (FIG. 5) is insertedthrough the incision I within the retrieval bag 130. The grasper 150 hasa pair of jaws 152, 154 extending from shaft 156 which are movablebetween open and closed positions to grasp the specimen S within cavityC and place it through the opening 132 into the bag 130. The grasper 150can also be utilized to maneuver the bag 130 over the specimen S. Thegrasper 150 also includes a net 160 positioned about (external) itsshaft 156. A portion 164 of the net 160 is everted. The net 160 has anelongated shape with a diameter smaller than the diameter of the tissuespecimen S intended to be removed. In this manner, when the specimen Sis placed within the net 160, it is compressed which facilitates removalas will be discussed in detail below. The net can be composed of apolymeric material, although other materials are also contemplated. Forexample, it can be formed of a molded plastic.

After placement of the specimen S in the bag 130, a second grasper 180is inserted through a port P extending through a second incision asshown in FIG. 6. The grasper 180 has a pair of movable jaws 182, 184extending from shaft 186. The grasper jaws 182, 184 are inserted throughthe opening 132 in the bag 130 to grasp the net 160 on grasper 150 andmaneuver the net 160 over the specimen S. More specifically, after thenet 160 has been pushed down along shaft 156 of grasper 150 so it ispositioned within the distal region of the bag 130, the jaws 182, 184grasp the rolled (everted) portion of the net 160 and pull it over thespecimen S. The grasper 180 preferably places the net 160 over theentire specimen S which tightly holds the specimen, and can compress thespecimen S to maintain it in an elongated shape, and prevent it fromslipping to the bottom of the net during removal. Thus, the netfunctions to grip the tissue specimen spreading the force needed towithdraw it over a large area, while also allowing the specimen toconform to the shape to the incision. The net preferably has a space atthe distalmost end to distend to prevent the tissue specimen fromreaching the bottom of the bag and balling up. Once retained by the net160, grasper 150 is removed from incision I. The second grasper 180 canalso be removed through the second incision at this time or removedafter the specimen S is removed. Note that the net preferably draws thespecimen up into it as it is placed over the specimen to hold ittherein.

As shown in FIG. 7, once the specimen S is retained within net 160, theuser grasps the proximal portion of the net 160 and retracts it towardthe incision I. The net 160 can operate in a “Chinese finger” fashion sothat applying a proximal retraction force on the net 160 elongates thenet and applies additional compression force on the specimen S. Once thespecimen S is firmly held within the net 160, the net 160 and bag 130are grasped by the user and removed through the incision I as shown inFIG. 8. Note that for removal the distal portion 115 of the rim 110 canbe rotated to change the orientation of the bag opening 132 so theopening 132 faces toward the incision I instead of facing transversely,thereby the closed end 134 of the bag 130 would support or protect thespecimen during removal.

Note the specimen can be maintained such that its long axis issubstantially parallel to the incision which reduces the force requiredfor removal through the incision or port. Also, as can be appreciated,the orientation and shape of the specimen S is substantially maintainedto facilitate not only removal but pathology. Moreover, any compressionor stretching of the specimen prior to removal occurs inside the bagwhich minimizes the risk of seeding.

Note also that the tissue specimen bags before containment so the riskof seeding is minimized. Also, since the net is taking the load, not theretrieval bag, the bag can be made of a thinner and lighter weightmaterial and can be made more transparent.

As can be appreciated, the patient's body and cavity are shownschematically, it being understood that the surgical retrieval apparatusof the present disclosure can be used in the thoracic cavity, theabdominal cavity and other areas of the body for minimally invasivesurgery.

A lubricious coating can be placed on the external surface of thespecimen retrieval bags described herein to facilitate removal throughthe port or incision.

Although the illustrative embodiments of the present disclosure havebeen described herein with reference to the accompanying drawings, theabove description, disclosure, and figures should not be construed aslimiting, but merely as exemplifications of particular embodiments. Itis to be understood, therefore, that the disclosure is not limited tothose precise embodiments, and that various other changes andmodifications may be effected therein by one skilled in the art withoutdeparting from the scope or spirit of the disclosure.

1. (canceled)
 2. A specimen retrieval system comprising: a delivery tubedefining a longitudinal axis and including a surgical retrievalapparatus contained therein configured to be inserted through a firstopening in a patient's skin, the delivery tube defining an internalvolume extending from a proximal end to a distal end of the deliverytube, the surgical retrieval apparatus separable from the delivery tube;the surgical retrieval apparatus including a support member, and aretrieval bag extending from the support member, the support memberdefining an opening configured to receive a tissue specimen into theretrieval bag, the support member and the retrieval bag defining aproximal end and a distal end, the proximal end and distal end of thesupport member and retrieval bag defining a major axis of the supportmember and defining a minor axis orthogonal to the major axis, whereinthe support member and the retrieval bag are movable between a firstcollapsed configuration and a second expanded configuration, whereinwhen moved at least partially outside the delivery tube, the supportmember automatically expands at least a portion of the retrieval bagalong the major axis and the minor axis towards the second expandedconfiguration maintaining the major axis and the minor axis, theconfiguration of the at least a portion of the opening of the supportmember and of the at least a portion of the retrieval bag being largerthan a configuration of the at least a portion of the opening of thesupport member and of the at least a portion of the retrieval bag thatremains inside the delivery tube to facilitate receiving the specimeninto the retrieval bag.
 3. The specimen retrieval system according toclaim 2, further comprising a first grasper including a pair of jaws anda shaft, the shaft having a net positioned on an external surfacethereof proximal to the pair of jaws.
 4. The specimen retrieval systemaccording to claim 3, wherein the net is positionable over the pair ofjaws when the pair of jaws is in a closed configuration with the tissuespecimen grasped therebetween.
 5. The specimen retrieval systemaccording to claim 3, wherein the net includes an everted distal end. 6.The specimen retrieval system according to claim 5, further including asecond grasper configured to grasp the everted distal end of the net tofacilitate placement of the net over the tissue specimen positionedwithin the retrieval bag.
 7. The specimen retrieval system according toclaim 2, wherein the support member defines a rim movable from acollapsed configuration when positioned within the delivery tube to anat least partially expanded configuration when advanced from thedelivery tube, the rim defines the opening of the support member that isconfigured to receive a tissue specimen when the rim is in the at leastpartially expanded configuration.
 8. The specimen retrieval systemaccording to claim 7, wherein the proximal portion of the retrieval bagfacilitates maintaining at least a portion of the rim external of theincision in a patient's skin when the rim is in the at least partiallyexpanded configuration.
 9. The specimen retrieval system according toclaim 7, wherein the rim forms a flexible path in the expandedconfiguration, the flexible path extending from the proximal portion ofthe retrieval bag outside of the incision to the distal portion of theretrieval bag that is configured to extend into a body cavity accessiblevia the incision.
 10. The specimen retrieval system according to claim9, wherein the opening defined by the rim extends from the proximalportion of the retrieval bag to the distal portion of the retrieval bagand maintains the major axis and the minor axis to further define aninternal volume of the retrieval bag without the presence of otherstructures.
 11. The specimen retrieval system according to claim 10,wherein the retrieval bag defines an interior surface limiting theinternal volume with respect to the opening, both a portion of theopening that is configured to extend distally into the body cavityaccessible via the incision and the internal volume of the distalportion of the retrieval bag presenting an unobstructed path to receivethe tissue specimen.
 12. The specimen retrieval system according toclaim 10, wherein the separation of the delivery tube from the retrievalbag enables the delivery tube to be removed from the body cavity throughthe incision prior to receipt of the tissue specimen in the internalvolume of the retrieval bag.
 13. The specimen retrieval system accordingto claim 10, wherein the distal portion of the retrieval bag that isconfigured to extend distally into the body cavity remains penetratingthe incision following removal of the delivery tube from the body cavitythrough the incision.
 14. The specimen retrieval system according toclaim 3, wherein the net is advanceable along the external surface ofthe shaft of the first grasper for placement over the tissue specimenreceived within the retrieval bag.
 15. The specimen retrieval systemaccording to claim 3, wherein the net comprises at least one of apolymeric material and a molded plastic.
 16. The specimen retrievalsystem according to claim 3, wherein the net comprises an elongatedshape with a diameter smaller than a diameter of the tissue specimenintended to be removed.
 17. The specimen retrieval system of claim 10,wherein the opening defines a distance between a proximal most point ofthe proximal portion of the retrieval bag and a distal most point of thedistal portion of the retrieval bag, and wherein the distance has amid-point between the proximal most point of the proximal portion of theretrieval bag and the distal most point of the distal portion of theretrieval bag, the opening extending from the proximal portion of theretrieval bag to the distal portion of the retrieval bag a distancegreater than the distance from the proximal portion of the retrieval bagto the mid-point of the opening.
 18. A surgical retrieval apparatuscomprising: a specimen retrieval bag including a rim movable from acollapsed configuration when positioned within a delivery tube to anautomatically expanded configuration when advanced from the deliverytube, the rim configured to receive a tissue specimen when the rim is inthe expanded configuration, the retrieval bag defining a proximalportion with respect to the incision and a distal portion with respectto the incision.
 19. The surgical retrieval apparatus according to claim18, wherein the rim forms a flexible path in the expanded configuration,the flexible path extending from the proximal portion of the retrievalbag outside of the incision to the distal portion of the retrieval bagthat is configured to extend into a body cavity accessible via theincision.
 20. The surgical retrieval apparatus according to claim 18,wherein the rim defines a vertical opening in the retrieval bag, thevertical opening defined by the rim extending from the proximal portionof the retrieval bag to the distal portion of the retrieval bag tofurther define an internal volume of the retrieval bag without thepresence of other structures.
 21. The surgical retrieval apparatusaccording to claim 20, wherein the retrieval bag defines an interiorsurface limiting the internal volume with respect to the verticalopening, both a portion of the opening that is configured to extenddistally into the body cavity accessible via the incision and theinternal volume of the distal portion of the retrieval bag presenting anunobstructed path to receive the tissue specimen.
 22. The surgicalretrieval apparatus according to claim 19, further comprising a deliverytube insertable through an incision in a patient's skin, the deliverytube defining an internal volume extending from a proximal end to adistal end of the delivery tube.
 23. The surgical retrieval apparatusaccording to claim 22, wherein the delivery tube is configured to enablethe delivery tube to be removed from the body cavity through theincision to prior to receipt of the tissue specimen in the internalvolume of the retrieval bag.
 24. The surgical retrieval apparatusaccording to claim 22, wherein the distal portion of the retrieval bagthat is configured to extend distally into the body cavity remainspenetrating the incision following removal of the delivery tube from thebody cavity through the incision.
 25. The surgical retrieval apparatusaccording to claim 18, wherein the proximal portion of the retrieval bagfacilitates maintaining at least a portion of the rim external of theincision in a patient's skin when the rim is in the expandedconfiguration.
 26. The surgical retrieval apparatus according to claim18, wherein the surgical retrieval apparatus is separable from thedelivery tube.